How do we know where ASD ends and comorbids begin?

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Recidivist
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22 May 2023, 8:00 am

Joe90 wrote:
Thank you Recidivist, that was an interesting article.

I also read that autism is basically all about anxiety or is a neurodevelopmental anxiety disorder. I'm not sure how true this is. I've always been anxious, but my NT mum had an anxiety disorder too and could get just as anxious as I get.

How do we tell the difference between anxiety disorder and autism?


ADDitude is a great resource for ADHD related articles, you might find it useful to do the The ADDitude Symptom Checker which will guide you through a series of questions based on your primary concerns, and then compare your responses to symptoms of more than a dozen common psychological and learning conditions. At the end, you will receive a list of the psychiatric or learning conditions (if any apply) with symptoms similar to those you cited — and resources for further exploration.


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IsabellaLinton
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22 May 2023, 9:01 am

Dude - It gave me six conditions.

Is that normal, or does everyone get all six and they just put them in order of severity?

I'm confused because none of them are quantified.

Look at my first one (LMAOOOO :hail: ) -- I don't know how I got that at all.


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22 May 2023, 10:22 am

I think I have OCD, not the washing hands type or keeping things neat type, but I mean the obsessive thoughts type, where I can't rest until I have expressed my thoughts that keep nagging in my head and sometimes can make me paranoid - but not like schizophrenia. There are no voices or anything like that, just feelings more like, or emotional thoughts. I don't know, but definitely not schizophrenia.

I definitely have anxiety disorder and although I'm sociable I still have social anxiety, especially when out in public.

I get bouts of depression which is tied with self-loathing.

I have PTSD from my high school days that contributes to my social anxiety and paranoia (thinking people are judging or out to get me).

And RSD. I'm beginning to hate RSD, as it seems to make me appear as a manic, neurotic, oversensitive, paranoid, self-obsessed freak online. I've always had RSD but I hadn't heard of it until recently, on an ADHD Facebook group. When I was 17 I remember first impressions going really badly when I first met new people at college, that I got overwhelmed with social anxiety and depression and had panic attacks, so I couldn't face going in to college for a week or two.


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IsabellaLinton
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22 May 2023, 10:33 am

Did you do the quiz, Joe?


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22 May 2023, 11:52 am

Which of these things are diagnosed by observable behavior, and which are diagnosed by observable differences in biology, which then result in some kind of effect? If it is just behavior, you don't really know anything.

EX) Sally has been observed to avoid eye contact.

*Does Sally EVER look at another person's eyes, or does she look at them quickly and then look away?
*Does Sally avoid every person's eyes, or just the eyes of certain people?
*Does she always avoid eyes, or just in certain situations?
*and so on and so forth

The eye contact aversion could be cultural, anxiety with autism, anxiety without autism, distraction with ADHD, distraction without ADHD, poor vision, or lots of other things

And then let's say we're looking at biology. I don't know a great deal about this, but let's take for example a small bit that I DO know.

Because lots of autistic people have donated their brains "For Science", the "Scientists" have noticed that autists seem to have smaller cerebellums than others. However, they are not sure why this is. Are the cerebellums becoming smaller over time, or are they just naturally smaller for autistic people? I have a cerebellar problem myself, so I happen to know that most of what the cerebellum does is control your smooth movement. There are not a lot of autistic ballerinas. There are more clumsy people. But no one knows why or if that is important. So if you happened to see a biological difference, you're still almost at square one.

TLDR: It is up to you to decide where ASD ends and a comorbidity begins. Many symptoms overlap. You may not have one or more conditions you have been diagnosed with.



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22 May 2023, 1:02 pm

IsabellaLinton wrote:
Dude - It gave me six conditions.

Is that normal, or does everyone get all six and they just put them in order of severity?

I'm confused because none of them are quantified.

Look at my first one (LMAOOOO :hail: ) -- I don't know how I got that at all.


It's just a symptom checker not a diagnostic tool, you either do your own research or take the results to a shrink.
When I did mine I only got two conditions ADHD & SPD in that order so yes it's normal (it undiagnosed my autism, yay, one less thing to worry about), is it accurate? Dunno, only a shrink can tell you that.


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IsabellaLinton
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22 May 2023, 1:26 pm

I think I have Tourette's but apparently there's no test for it. It's hard to say where Tourette's starts and stimming, RBFBs, and echolalia begin. As for OCD I really don't think I have it but maybe there were questions about rumination etc., and I do those because of ASD. Kind of odd I didn't get Depression, but whatever! That's fine!

Great test though!
I really like how it was structured and went into so many areas.
ADD-itude is always such a great resource.

Another friend of mine got 8 things, so I guess we're all different!


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IsabellaLinton
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22 May 2023, 1:48 pm

Joe90 wrote:
IsabellaLinton wrote:
I don't know how to answer. Comorbids are co-occurring conditions so I don't think there's one "primary" diagnosis and the comorbids are secondary. Afaik they can be equally strong and happening at the same time. If there's overlap it would be like a Venn diagram where many symptoms are written twice in the same circle, but the edges of the circles have their own unique traits which aren't shared.

I sense however that if ASD and ADHD were diagnosed at the same time ASD would probably be listed first, since it's neurodevelopmental. Then again I think ADHD is also neurodevelopmental, but somehow autism is usually considered to have come first. Maybe ASD starts at the moment of conception or when the brain is built, and ADHD starts later in gestation? (irdk - just guessing).

Another thought is that ADHD can be somewhat controlled by drugs so maybe they assume it's not as intractable as ASD.

Are you able to contact your ADHD doctors to ask these questions? Maybe if you were to try ADHD meds and see how they affect your mood and behaviour, you'll notice all or most of the "ASD stuff" seems to go away? That might be a good way to check how prominent your ADHD really is. I'm loving this new med Intuniv. It's helping me a lot with ADHD but I can still note my ASD alive and kicking underneath.

Do you still have ADHD symptoms though? I feel ADHD is part of who I am and I like some of my ADHD symptoms and behaviours. I wouldn't want meds to take that away.



Yes I still have ASD and ADHD symptoms and I'm still "me" very much. If anything I feel like a better version of me. Instead of my brain feeling like it's a tangled knot of thoughts, sensations, emotions, and weirdness, now the knot feels untied. All the thoughts, sensations, emotions, and weirdness are still there, but now it's like they're organised smoothly instead of being a hot mess. I still don't feel like I'm Neurotypical. I still have all the quirky things from before. Synaesthesia didn't stop, having SPD didn't stop. Nothing really stopped but at least I can breathe and it's not all piled together like being hit by an avalanche. That's how my brain felt before and it made me anxious. Now my anxiety is subsiding because I'm not so tangled, and I can think linear thoughts from start to end.

I've only taken this stuff seven times but wow --- it's a HUGE help.


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22 May 2023, 2:04 pm

IsabellaLinton wrote:
Dude - It gave me six conditions.

@Isabella, it only gave me two: SPD and ADHD. Weird since I am super anxious today and my official diagnoses are GAD and ASD. I must have interpreted the questions too literally as usual ---- another peg in the coffin of how I can't get anyone in my family diagnosed correctly, including myself. :P I asked my evaluator about SPD, but he said it may have applied as a child, but not now. I didn't know to ask about ADHD - he suspected a mood disorder instead of ADHD and I didn't know anything about ADHD at the time, but it's a really good fit for me now that I do.

Thanks for the link @Recidivist.

@Joe, I think any ND has degrees of all those "conditions" and it makes up their picture. So it's a matter of which one is more prominent or the most challenging for them, which varies over time and support.

bee33 wrote:
I also don't completely understand the link between ASD and ADHD. As far as myself, I know I am not at all hyperactive. I'm not even bad at paying attention. And aren't people with ASD supposed to be hyperfocused? That seems like the opposite of a deficit in attention. I'm not disputing that there is a link, and that many people have both ASD and ADHD, because it seems to have been clearly established, I just don't really understand it.

@bee33, I am AuDHD. If I am interested in a subject, I have hyperfocus going on. If I am not interested in a subject, I am completely spacing. Take for example a staff meeting... mostly unbearable. Doodling helps me stay engaged. My daughter has ASD, my son has ADHD and I have both. It's my daughter and I who can do something for hours. It's my son and I who can't wait in line. etc.



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22 May 2023, 2:07 pm

Mine came back with ODD. f**k that!


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22 May 2023, 2:10 pm

I am diagnosed with ASD, ADHD, GAD or Anxiety, and SPD.
SPD was diagnosed in my ASD testing as well as a private Occupational Therapist.
She calls it SID or Sensory Integration Disorder.

In that respect I wasn't surprised by those four, or even by Tourette's.
I'm asking my doctor about Tourette's later this week.

I'm not sure what the other possible results are besides Depression.
I think I saw Bipolar mentioned in the intro.
I know I don't have Bipolar or Borderline or Schizophrenia as I've been tested quite a bit for those.
I think it said there's 12 options? (Must re-read .... but ADHD lol ....)

It's odd the Depression didn't pop up for me, but whatever. Good to know.

OCD was the only curious one but I can accept it.
It's just strange no one has dx that before for me.
I don't have any compulsive behaviours beyond stimming.
Obsessive? idk - Rabbit hole thinking is about all.
I don't have preoccupations about tidiness or checking things repeatedly.


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22 May 2023, 2:19 pm

According to Dr. ADDitude I've got Bipolar, Depression, ADHD, Autism, Tourette's, ODD, SPD and Anxiety. 8O

I don't believe I'd meet the criteria for Tourette's, the others all seem reasonable.


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22 May 2023, 2:33 pm

My results: OCD, depression, autism, ADHD, and SPD.

It’s accurate except for the OCD. I don’t have compulsions and haven’t been diagnosed with that. I have GAD and PTSD.



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22 May 2023, 2:36 pm

I think a lot of us are going to get an OCD result because of our autistic brains.
It might give a different result if we could have told it we were autistic before starting.


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22 May 2023, 2:40 pm

It's almost like it doesn't do any differential diagnosis and instead gives a list of everything that might be relevant.

This makes sense, if the goal is to get people to discuss things with professionals. The doctor will perform the DD.


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22 May 2023, 2:54 pm

IsabellaLinton wrote:
I don't have any compulsive behaviours beyond stimming.


Twilightprincess wrote:
I don’t have compulsions


FYI if you have 'purely obsessional OCD' aka 'Pure O' you will experience mental compulsions but you might not be aware of them. Because they are not as obvious as physical compulsions, it can sometimes be difficult to define exactly what these compulsions are.

I also think compulsions are not needed for a diagnosis of OCD - cant remember now :?:

DSM V says compulsions are not needed for Dx


Quote:
A. Presence of obsessions, compulsions, or both:

Obsessions are defined by (1) and (2):

1 Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
2 The individual attempts to ignore or suppress such thoughts, urges, or images, or to neutralize hem with some other thought or action (i.e., by performing a compulsion).

Compulsions are defined by (1) and (2):

1 Repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g., praying, counting, repeating words silently) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly.
2 The behaviors or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent, or are clearly excessive

https://www.ocduk.org/ocd/clinical-clas ... m-and-ocd/
.


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Last edited by Recidivist on 22 May 2023, 3:09 pm, edited 1 time in total.